Early intravenous gamma-globulin treatment for kawasaki disease: The nationwide surveys in Japan

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Abstract

Objective

To determine the optimal period of intravenous gamma-globulin (IVGG) treatment, using the database from nationwide Kawasaki disease surveys in Japan.

Study design

We selected patients who first visited a doctor within 3 days of illness and received IVGG treatment within 9 days of illness. We divided these patients into 2 groups: an early group (treated on days 1-4: 4731 cases) and a conventional group (days 5-9: 4020 cases). We compared the rate of additional IVGG and prevalence of cardiac sequelae between these groups.

Results

The rate of additional IVGG in the early group was significantly higher than those of the conventional group (OR, 1.12 [95% CI, 1.10-1.16]). There were no significant differences in cardiac sequelae between the two groups.

Conclusions

There is no evidence that IVGG treatment on day 4 or earlier has greater efficacy in preventing cardiac sequelae than treatment on days 5 to 9. In addition, early treatment is likely to result in a greater requirement for additional IVGG. However, there is also no evidence that early treatment increases the prevalence of cardiac sequelae in a clinical practice setting, where additional IVGG can be given to those whose initial treatment fails.

Section snippets

Methods

The Japan KD Research Committee has conducted nationwide surveys since 1970.7 The participants of these surveys are patients with KD who were diagnosed at hospitals with 100 beds or more. A questionnaire form is sent to the hospitals, with a pamphlet describing the diagnostic criteria of the disease and including color pictures of typical lesions of the skin, eyes, hands, and feet.7 We used the database of the 15th (from 1997 to 1998) and 16th (from 1999 to 2000) nationwide surveys. The total

Results

The characteristics of these groups are shown in Table I. There were no significant differences between the two groups in sex and IVGG dose per day. The early treatment group was significantly younger than the conventional treatment group (P<.001). The ratio of suspected cases in the early treatment group was significantly higher than that in the conventional group (P = .002). The total IVGG dose in initial treatment in the early treatment group was significantly higher than that of in the

Discussion

In this study, we investigated the optimal period of IVGG treatment. According to the US criteria, patients cannot be diagnosed before 5 days after onset.9 However, in the presence of classic features, the diagnosis of KD may be made by experienced observers before day 5 of fever. There were no significant differences in acute cardiac abnormalities and cardiac sequelae between the early treatment group and the conventional treatment group. According to a case-control study by Sugahara et al,3

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Supported in part by Grants-in-Aid 14570786 and 14770379 from the Ministry of Education, Culture, Sports, Science, and Technology, the Japanese Kawasaki Disease Research Committee, and the Mother and Child Health Foundation of Japan.

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